Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Friday, October 05, 2007

Losing Control

"Doctor, your patient's blood pressure really low, it's 60/40!"

"Wha....??? What happened?"

"I don't know doctor. I know he had that catheter ablation yesterday where you poked holes in the patient's legs and thread catheters to all kinds of chambers in his heart to ablate his atrial fibrillation, and he was doing so well..."

"So what the hell happened?"

"Nothing."

"What do you mean, 'Nothing?'"

"Well, I guess I gave him that flu shot."

"What flu shot?"

"That one that you ordered."

"I didn't order a flu shot!"

"The computer says you did."

"What the hell are you talking about?"

"Our computer says that all patients will get a flu shot if they are over 50 and a pneumovax vaccine if they're over 65 as part of the quality assurance initiative, so they added it to your orders. And I went ahead and gave it, because the patient didn't refuse, and I have to take off all of the orders, you know."

I did an outpt pre-op eval on a pt going to surgery.When he got admitted post op the ICU nurse used my name for a routine protocol order for an MRSA screen.I then got notified that he was MRSA positive. Aggravated the heck out of me because I was not even responsible for his care in the hospital. The vascular surgeon was.

Flu vaccine is usually grown in fertilized chicken eggs. Both types of flu vaccines are contraindicated for those with severe allergies to egg proteins due to the potential for anaphylaxis and its associated drop in blood pressure.

Thank you JCAHO or whatever inane regulatory agency says we have to assess your alcoholic intake, see if you are a victim of domestic violence, check if you have an advance directive, fill out the medication reconciliation form, find out your vaccination status and so on and so on and so on.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.